How severe is moderately severe acute pancreatitis? Clinical validation of revised 2012 Atlanta Classification

AIM To explore the outcomes and the appropriate treatment for patients with moderately severe acute pancreatitis(AP).METHODS Statistical analysis was performed on data from the prospectively collected database of 103 AP patients admitted to the Department of Surgery,Hospital of Lithuanian University of Health Sciences in 2008-2013. All patients were confirmed to have the diagnosis of AP during the first 24 h following admission. The severity of pancreatitis was assessed by MODS and APACHE Ⅱ scale. Clinical course was re-evaluated after 24,48 and 72 h. All patients were categorized into 3 groups based on Atlanta 2012 classification: Mild,moderately severe,and severe.Outcomes and management in moderately severe group were also compared to mild and severe cases according to Atlanta 1992 and 2012 classification.RESULTS Fifty-three-point four percent of patients had edematous while 46.6 % were diagnosed with necrotic AP. The most common cause of AP was alcohol(42.7%) followed by alimentary(26.2%),biliary(26.2%) and idiopathic(4.9%). Under Atlanta 1992 classification 56(54.4%) cases were classified as "mild" and 47(45.6%) as "severe". Using the revised classification(Atlanta 2012),the patient stratification was different: 49(47.6%) mild,27(26.2%) moderately severe and 27(26.2%) severe AP cases. The two severe groups(Atlanta 1992 and Revised Atlanta 2012) did not show statistically significant differences in clinical parameters,including ICU stay,need for interventional treatment,infected pancreatic necrosis or mortality rates. The moderately severe group of 27 patients(according to Atlanta 2012) had significantly better outcomes when compared to those 47 patients classified as severe form of AP(according to Atlanta 1992) with lower incidence of necrosis and sepsis,lower APACHE Ⅱ(P = 0.002) and MODS(P = 0.001) scores,shorter ICU stay,decreased need for interventional and surgical treatment.CONCLUSION Study shows that Atlanta 2012 criteria are more accurate,reduce unnecessary treatments for patients with mild and moderate severe pancreatitis,potentially resulting in health costs savings.

Risk Management Concepts in Dam Safety Evaluation： Mosul Dam as a Case Study

Gradual shift has been observed lately of dam safety procedures from the conventional technical based towards a wider scope of risk management procedure based on risk analysis. The new approach considers the likelihood level of occurrence of a multitude of hazards and the magnitude of the resulting possible consequences in case of failure using rational cause and effect arguments. Most dam owners are shifting towards the use of the new risk based procedures; and even governments themselves are moving towards formalizing the new trend. Legislations in the United States were promulgated [1] after serious dam failures and the adoption of stringent levels of scrutiny led such federal dam owners to pioneer in this field and in developing the concepts and methods required. The comer stone in risk analysis is the definition of the potential modes that may lead to failure and assessment of the likelihood levels of their occurrence and possible category of the consequences which, after thorough evaluation, will shape the decision making. This type of analysis was applied to Mosul Dam as a case study and resulted in definite recommendations.

Exploration and Practice of Improving Higher Mathematics Teaching Quality of Teaching at Different Levels

Teaching content of Higher Mathematics is systematic and rigor with a high degree of abstraction. Because different students are on the different basis and different disciplines have various requirements, mathematics is generally difficult for students. In order to improve the quality of teaching mathematics, we should make use of individualized teaching and teaching by different levels in order to achieve the best teaching results.